Education and the Health Professions: Explaining Policy Choices among the States

Abstract

Recent calls for restructuring of the nation's health care system have highlighted the deficiencies in the current system of education for the health professions. Of particular concern are the dominance of specialization and hospital-based training and the tendency of new health care providers to settle in communities without substantial health needs. The states are the key actors in reforming health professions education, serving as a primary funding source for health professions schools, chief licensors and regulators of health professions, regulators of private health insurance, key providers of Medicaid, and architects of a variety of subsidy and regulatory programs providing incentives for health professionals to choose specialties and locations for practice. This article provides a taxonomy of state policies affecting health professions education reform and classifies the states according to the choices they have made. Findings show that few states take advantage of their policy options across the four policy types and that most tend to concentrate their efforts on a few policies--ignoring potential means of encouraging more primary care providers in underserved areas. Results from regression models explaining state choice of policy adoption highlight the political nature of policy choice and the highly variable nature of state response in health professions education reform.

Outcomes of States’ Scholarship, Loan Repayment, and Related Programs for Physicians

“…24 We confirmed that, indeed, obligated physicians worked in counties with primary care physician-to-population ratios lower than their state's median county ratios more often than nonobligated physicians (37% vs. 11%, P Ͻ0.001).…”

State Scholarship, Loan Forgiveness, and Related Programs

“…10 States also recognized that their programs' smaller size make them more manageable, and their closer relationships with communities give them advantages in innovation and flexibility. 13,29,30 Indeed, the New Federalism doctrines in recent years have encouraged innovation by states as "policy laboratories." 27,29 State support-for-service programs also grew to fill a workforce void left when NHSC staffing dwindled in the late 1980s and when President Clinton's health care workforce reform proposals were defeated in the early 1990s.…”

“…9 From 1985 through 1992, the pace of program growth quickened, with 35 states enacting legislation to create physician scholarships and similar programs. 12,13 Despite states' investments, little is known about their service-requiring programs. No national organization or central public agency monitors these programs.…”

State Legislative Activities Related to Elimination of Health Disparities

“…Recent examples include Hahn et al 1999 on tobacco policy; Kaskie, Knight, and Liebig 2001 on state dementia laws; Oliver 1999 and Morrisey and Jensen 1997 on insurance; Lear, Eichner, and Koppelman 1999 on the growth of school-based health centers; and Alexander and Succi 1996, Potter and Longest 1994, and Weissert, Knott, and Stieber 1994 on various provider issues. We believe this is the first such study of state legislative actions on this issue.…”